Provider Demographics
NPI:1538441142
Name:HOLLAND, WILLIS VICTOR (RPH)
Entity type:Individual
Prefix:MR
First Name:WILLIS
Middle Name:VICTOR
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 LOVE AVE
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-4405
Mailing Address - Country:US
Mailing Address - Phone:229-382-5359
Mailing Address - Fax:229-382-5231
Practice Address - Street 1:615 LOVE AVE
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4405
Practice Address - Country:US
Practice Address - Phone:229-382-5359
Practice Address - Fax:229-382-5231
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist